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Surgical Endoscopy
Published in: Surgical Endoscopy 10/2009

01-10-2009

The association between central venous pressure, pneumoperitoneum, and venous carbon dioxide embolism in laparoscopic hepatectomy

Authors: S. Jayaraman, A. Khakhar, H. Yang, D. Bainbridge, D. Quan

Published in: Surgical Endoscopy | Issue 10/2009

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Abstract

Background

Laparoscopic hepatectomy (LH) is increasingly used. However, the safety and outcomes of LH have yet to be elucidated. The risk of venous gas embolism is increased during liver parenchymal transection. This risk may be increased with positive pressure carbon dioxide (CO2) pneumoperitoneum (PP). This may be exacerbated further when low central venous pressure (CVP) anesthesia is used to minimize hemorrhage during liver resection.

Methods

To determine the risk of CO2 venous embolism, hand-assisted laparoscopic left hepatic lobectomy was performed for 26 domestic pigs. They were divided into three groups involving, respectively, positive gradient (normal-pressure PP of 12–14 mmHg and low CVP of 5–7 mmHg), negative gradient (low-pressure PP of 7–8 mmHg and normal CVP of 10–12 mmHg), and neutral gradient (normal-pressure PP and normal CVP or low-pressure PP and low CVP). Transesophageal echocardiography (TEE) was used intraoperatively to assess the presence of emboli in the suprahepatic vena cava and the right side of the heart. The TEE was recorded and analyzed by blinded observers. Carbon dioxide embolism also was monitored using end-tidal CO2 and compared with TEE.

Results

Carbon dioxide embolism was demonstrated in 19 of the 26 cases. The majority of gas emboli were small gas bubbles associated with dissection of the major hepatic veins. No statistically significant difference in the occurrence of gas emboli was observed between the groups. Of the 19 animals, 18 experienced no significant hemodynamic changes. One pig in the positive gradient group experienced hypotension in relation to gas embolism. The effects were only transient and did not preclude safe completion of the operation.

Conclusions

Carbon dioxide embolism during LH occurs frequently. Clinically, this finding appears to be nominal, but care must be taken when dissection around large veins is performed, and awareness by the surgical and anesthesiology teams of potential venous air embolism is essential. Further evaluation of this phenomenon is required.
Literature
1.
Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL (2003) Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg 196:236–242CrossRefPubMed
2.
Gigot JF, Glineur D, Satiago-Azagra J, Goergen M, Ceuterick M, Morino M, Etienne J, Marescaux J, Mutter D, van Krunckelsven L, Descottes B, Valleix D, Lachachi F, Bertrand C, Mansvelt B, Hubens G, Saey J-P, Schockmel R (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236:90–97CrossRefPubMed
3.
Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick R, Lillemoe KD, Yeo CJ, Cameron JL (2002) Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 235:759–765CrossRefPubMed
4.
Marin-Hargreaves G, Azoulay D, Bismuth H (2003) Hepatocellular carcinoma: surgical indications and results. Crit Rev Oncol Hematol 47:13–27CrossRefPubMed
5.
Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, Corvera C, Weber S, Blumgart LH (2002) Improvement in perioperative outcome after hepatic resection analysis of 1, 803 consecutive cases over the past decade. Ann Surg 236:397–407CrossRefPubMed
6.
Qin LX, Tang ZY (2002) The prognostic significance of clinical and pathological features in hepatocellular carcinoma. World J Gastroenterol 8:193–199PubMed
7.
DeMatteo RP, Fong Y, Jarnagin WR, Blumgart LH (2000) Recent advances in hepatic resection. Semin Surg Oncol 19:200–207CrossRefPubMed
8.
Jones BR, Moulton CE, Hardy KJ (1998) Central venous pressure and its effect on blood loss during liver resection. Br J Surg 85:1058–1060CrossRefPubMed
9.
Melendez J, Ferri E, Fischer ME, Wuest D, Jarnagin WR, Fong Y, Blumgart LH (1998) Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg 187:620–625CrossRefPubMed
10.
Lantz PE, Smith JD (1994) Fatal carbon dioxide embolism complicating attempted laparoscopic cholecystectomy: case report and literature review. J Forensic Sci 39:1468–1480PubMed
11.
Schmandra TC, Mierkl S, Bauer H, Gutt C, Hanisch E (2002) Transoesophageal echocardiography shows high risk of gas embolism during laparoscopic hepatic resection under carbon dioxide pneumoperitoneum. Br J Surg 89:870–876CrossRefPubMed
12.
Laurence JM, Lam VW, Langcake ME, Hollands MJ, Crawford MD, Pleass HC (2007) Laparoscopic hepatectomy: a systematic review. ANZ J Surg 77:948CrossRefPubMed
13.
Cherqui D, Laurent A, Tayar C, Chang S, Van Nhieu JT, Loriau J, Karoui M, Duvoux C, Dhumeaux D, Fagniez P-L (2006) Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg 243:499–506CrossRefPubMed
14.
Buell JF, Koffron AJ, Thomas MJ, Rudich S, Abecassis M, Woodle ES (2005) Laparoscopic liver resection. J Am Coll Surg 200:472–480CrossRefPubMed
15.
Koffron AJ, Auffenburg G, Kung R, Abecassis M (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246:385–392CrossRefPubMed
16.
Tsalis K, Blouhos K, Vasiliadis K, Kalfadis S, Tsachalis T, Savvas I, Betsis D (2007) Bloodless laparoscopic liver resection using radiofrequency thermal energy in the porcine model. Surg Laparosc Endosc Percutan Tech 17:22–25CrossRefPubMed
17.
Bazin JE, Gillart T, Rasson P, Conio N, Aigouy L, Schoeffler P (1997) Haemodynamic conditions enhancing gas embolism after venous injury during laparoscopy: a study in pigs. Br J Anaesth 78:570–575PubMed
18.
Jaskille A, Schechner A, Park K, Williams M, Wang D, Sava J (2005) Abdominal insufflation decreases blood loss and mortality after porcine liver injury. J Trauma 59:1305–1308CrossRefPubMed
19.
20.
Schmandra TC, Miekl S, Bauer H, Hanisch E, Gutt C (2004) Risk of gas embolism in hand-assisted versus total laparoscopic hepatic resection. Surg Technol Int 12:137–143PubMed
21.
Farges O, Jagot P, Kirstetter P, Marty J, Belghiti J (2002) Prospective assessment of the safety and benefit of laparoscopic liver resections. J Hepatobiliary Pancreat Surg 9:242–248CrossRefPubMed
22.
Jersenius U, Fors D, Rubertsson S, Arvidsson D (2007) Laparoscopic parenchymal division of the liver in a porcine model: comparison of the efficacy and safety of three different techniques. Surg Endosc 21:315–320.CrossRefPubMed
23.
Bazin JE, Schoeffler P (1997) Pigs are not humans. Br J Anaesth 79:691–692PubMed
24.
Koffron A, Geller D, Gamblin TC, Abecassis M (2006) Laparoscopic liver surgery: shifting the management of liver tumors. Hepatology 44:1694–1700CrossRefPubMed
Metadata
Title
The association between central venous pressure, pneumoperitoneum, and venous carbon dioxide embolism in laparoscopic hepatectomy
Authors
S. Jayaraman
A. Khakhar
H. Yang
D. Bainbridge
D. Quan
Publication date
01-10-2009
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 10/2009
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-009-0359-9

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